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1.
Medicine (Baltimore) ; 99(9): e19379, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118784

RESUMEN

To examine the willingness to pay (WTP) for a quality-adjusted life year (QALY) gained among advanced non-small cell lung cancer (NSCLC) patients in Viet Nam and to analyze the factors affecting an individual's WTP.A cross-sectional, contingent valuation study was conducted among 400 NSCLC patients across 6 national hospitals in Viet Nam. Self-reported information was recorded from patients regarding their socio-demographic status, EQ-5D (EuroQol-5 dimensions) utility, EQ-5D vas, and WTP for 1 QALY gained. To explore the factors related to the WTP, Gamma Generalized Linear Model and multiple logistic regression tools were applied to analyze data.The overall mean and median of WTP/QALY among the NSCLC patients were USD $11,301 and USD $8002, respectively. Strong association was recorded between WTP/QALY amount and the patient's education, economic status, comorbidity status, and health utility.Government and policymakers should consider providing financial supports to disadvantaged groups to improve their access to life saving cancer treatment.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/economía , Carcinoma de Pulmón de Células no Pequeñas/psicología , Financiación de la Atención de la Salud , Pacientes Internos/psicología , Años de Vida Ajustados por Calidad de Vida , Adolescente , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/terapia , Estudios Transversales , Femenino , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Vietnam
2.
Neuropsychiatr ; 34(1): 22-26, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-31970717

RESUMEN

BACKGROUND: Despite the demographic development and the increasing number of psychiatric diseases in older people, there are only few scientific investigations on the characteristics of patients in gerontopsychiatry and their mortality. In this retrospective case control study patient data were examined in order to establish which features of patients who died in a department of gerontopsychiatry show differences to those of patients who were discharged. METHOD: A total of 284 patient files from the department of gerontopsychiatry and geriatric psychotherapy of the State Hospital Graz II were evaluated. Between 1 January 2015 and 31 December 2017, a total of 51 women and 91 men died (= cases) in hospital. These patients were compared with 142 sex-matched patients (control group) who were discharged during the same period of time. The evaluation was carried out using logistic regression models. RESULTS: Patients who died on the geriatric psychiatry ward were clearly older and were in a clearly poorer physical state of health than the discharged patients. The deceased patients had a 2.7-fold higher chance of an ischemic cardiac disease as well as a 2.5-fold and 3.5-fold higher chance of being referred from a nursing home or hospital, respectively. They also had a threefold higher chance for a lower functional status, a fourfold increased chance of higher C­reactive protein (CRP) values and a diagnosis of delirium compared to discharged patients. CONCLUSION: The deceased patients had a substantially poorer state of health and tended to suffer more from delirium compared to the discharged patients. Structural health policy precautions must be undertaken so that unnecessary transfers to gerontopsychiatry departments do not become necessary.


Asunto(s)
Delirio/epidemiología , Delirio/psicología , Pacientes Internos/psicología , Pacientes Internos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Austria/epidemiología , Femenino , Humanos , Masculino , Estudios Retrospectivos
3.
Crit Care Nurs Q ; 43(1): 81-85, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31789881

RESUMEN

Music therapy (MT) in the inpatient setting has demonstrated positive outcomes worldwide. There was no protocol to utilize MT at this organization. The purpose of this project was to incorporate and evaluate MT as an adjunct intervention to address pain and anxiety in adult surgical step-down patients. Evidence-based practice change using the 8A's method integrated individualized MT provided by a board-certified music therapist to hospitalized patients over a 3-month period. Training was provided to 35 nurses and unit-assigned social worker on the utilization of MT for patients exhibiting pain or anxiety symptoms. The clinical social worker and staff nurses provided referrals for MT directly to the music therapist. Evaluation of MT included paired t-test and Wilcoxon signed-rank score comparisons of the numerical pain rating scale and the DSM-5 Patient Reported Outcome Measurement Information System Anxiety short form before and after the MT encounter. Among patients who received MT (n = 42), there was a statistically significant reduction in both pain (pre (Equation is included in full-text article.)= 6.07, post (Equation is included in full-text article.)= 3.45, t = 7.046, P = < .001) and anxiety (pre (Equation is included in full-text article.)= 56.47, post (Equation is included in full-text article.)= 46.52, t = 7.787, P ≤ .001). The reduction in pain (moderate to mild) and anxiety (mild to none) was also clinically significant.


Asunto(s)
Pacientes Internos/psicología , Musicoterapia , Manejo del Dolor , Procedimientos Quirúrgicos Operativos , Adulto , Ansiedad/psicología , Enfermería de Cuidados Críticos , Hospitalización , Humanos , Estrés Psicológico/psicología
4.
East Asian Arch Psychiatry ; 29(4): 118-123, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31871308

RESUMEN

OBJECTIVE: To determine the prevalence of adult attention deficit hyperactivity disorder (ADHD) and comorbid mental disorders in a Malaysian forensic mental hospital. METHODS: All adult patients admitted to the forensic wards who were able to understand Malay or English language and give written informed consent were included. Participants were assessed using the Conners Adult Attention-Deficit Diagnostic Interview for DSM-IV (for presence of adult ADHD and a history of childhood ADHD) and the Mini International Neuropsychiatric Interview (for psychiatric comorbidities). Sociodemographic and offence-related data were also collected. RESULTS: Of 199 patients admitted, 120 were included for analysis. The mean age of participants was 36.3 years. 94.2% were men. 81.7% were single, divorced, or separated. 25% had a history of childhood ADHD. The prevalence of adult ADHD was 15.8%. The persistence rate was 63%. Among the 19 participants with adult ADHD, the most common psychiatric comorbidities were substance dependence (68.4%), lifetime depression (63.2%), and generalised anxiety disorder (47.4%). Compared with participants without ADHD, participants with adult ADHD were less likely to be married (0% vs 21.8%, p = 0.022) and more likely to have alcohol abuse (15.8% vs 2%, p = 0.028), lifetime manic/hypomanic episodes (42.1% vs 7.9%, p = 0.001), and generalised anxiety disorder (47.4% vs 19.8%, p = 0.017), and were of younger age at first offence (21.8 years vs 26.9 years, p = 0.021). CONCLUSIONS: Adult ADHD is common in a Malaysian forensic mental hospital and is associated with unmarried status, alcohol abuse, lifetime manic/hypomanic episodes, generalised anxiety disorder, and younger age at first offence.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Psiquiatría Forense , Hospitales Psiquiátricos , Pacientes Internos/psicología , Pacientes Internos/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Malasia/epidemiología , Masculino , Prevalencia , Escalas de Valoración Psiquiátrica
5.
BMC Psychol ; 7(1): 72, 2019 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-31727151

RESUMEN

BACKGROUND: For some young persons diagnosed with anorexia nervosa, treatment will inevitably involve phases where hospitalization is required. Inspired by the encouraging evidence-base for outpatient family-based treatment for adolescent anorexia nervosa, clinicians and program developers have started to incorporate outpatient family-based treatment principles into higher levels of care. During family-based inpatient treatment, collaborative efforts are largely directed toward the parents of the adolescent. Consequently, the therapeutic focus on the young person is more of an indirect one. With this study we aimed to understand how young persons with lived experience from a family-based inpatient treatment setting, where the adolescents were admitted together with their parents, viewed therapeutic aspects related to staff-patient collaboration and staff-related behaviors. METHODS: Thirty-seven semi-structured interviews of former adolescent inpatients were conducted. Participants' post-treatment reflections were inductively analyzed by applying a thematic analytic framework. RESULTS: Based upon user perspectives from a treatment setting highly influenced by a family therapeutic approach, findings revealed that former inpatients prefer tailored treatment and a collaborative approach. Eight subthemes constituting two main themes emerged: 1) There are no ready-made solutions. Staff should facilitate collaboration by tailoring treatment toward the young person's perspectives, and 2) Emphasizing skills that matter. Staff should display a non-judgmental stance, educate patients, stimulate motivation, enable activities and prevent iatrogenic effects during the stay. CONCLUSIONS: This study adds valuable user perspectives to the ongoing work with adapting family-based frameworks into higher levels of care. Clinicians could benefit from viewing their practice from the standpoint of the young person's post-treatment reflections. From their unique perspectives as having lived experience and hence, "insider knowledge" with a specific treatment situation, clinicians are reminded of the importance of being mindful on the young persons' views.


Asunto(s)
Anorexia Nerviosa/terapia , Atención Plena , Relaciones Profesional-Paciente , Autocontrol/psicología , Adolescente , Adulto , Anorexia Nerviosa/psicología , Femenino , Humanos , Pacientes Internos/psicología , Masculino , Motivación , Investigación Cualitativa , Conducta Social
6.
J Music Ther ; 56(4): 381-402, 2019 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-31742643

RESUMEN

The MAP is an innovative receptive music therapy intervention derived from psychomusical relaxation methods that aims to foster the well-being and recovery of youths with mental health problems by providing them with an adaptive and effective music-assisted means to regulate their mood states. In this quasi-experimental pilot study, we assessed the mood-enhancing potential of participation in MAP sessions delivered by a music therapist in an in-patient mental health facility for children and adolescents. Using short standardized self-reported questionnaires, 20 participants aged 9-17 years old (M = 14, SD = 2.4), mainly girls (13 = 65%), rated their affective state immediately before and after two to four MAP sessions and a similar number of regular unit activity sessions used as comparison. This created a 2 × 2 (Time × Condition) single-group within-individual design. We analyzed pre-post session changes in affect using multilevel mixed models and found participation in MAP sessions to be associated with systematic reductions in self-reported general negative affect and state anxiety. These variations were of modest-to-large magnitude and significantly greater than those associated to participation in regular unit activities. While only a first step towards the validation of the MAP as an effective intervention to foster more adaptive and effective day-to-day mood regulation in youths with mental health problems, this study supports its specific potential to alleviate negative affects and provides a rare demonstration of the putative benefits of music therapy in a pediatric mental health inpatient context.


Asunto(s)
Pacientes Internos/psicología , Trastornos Mentales/rehabilitación , Musicoterapia/métodos , Música/psicología , Aceptación de la Atención de Salud/psicología , Terapia por Relajación/métodos , Adolescente , Afecto , Ansiedad/terapia , Niño , Emociones , Femenino , Humanos , Masculino , Salud Mental , Proyectos Piloto , Encuestas y Cuestionarios
7.
Med Care ; 57(11): 913-920, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31609847

RESUMEN

OBJECTIVE: There is limited knowledge about how general hospitals and Veterans Health Administration (VHA) hospitals fare relative to each other on a broad range of inpatient psychiatry-specific patient safety outcomes.This research compares data from 2 large-scale epidemiological studies of adverse events (AEs) and medical errors (MEs) in inpatient psychiatric units, one in VHA hospitals and the other in community-based general hospitals. METHOD: Retrospective medical record reviews assessed the prevalence of AEs and MEs in a sample of 4371 discharges from 14 community-based general hospitals (derived from 69,081 discharges at 85 hospitals) and a sample of 8005 discharges from 40 VHA hospitals (derived from 92,103 discharges at 105 medical centers). Rates of AEs and MEs across hospital systems were calculated, controlling for relevant patient and hospital characteristics. RESULTS: The overall rate of AEs and MEs in inpatient psychiatric units of VHA hospitals was 7.11 and 1.49 per 100 patient discharges; at community-based acute care hospitals, these rates were 13.48 and 3.01 per 100 patient discharges. The adjusted odds ratio of a patient experiencing an AE and a ME at community-based hospitals as compared with VHA hospitals was 2.11 and 2.08, respectively. CONCLUSION: Although chart reviews may not document the complete nature and outcomes of care, even after controlling for differences in patient and hospital characteristics, psychiatric inpatients at community-based hospitals were twice as likely to experience AEs or MEs as inpatients at VHA hospitals. While community-based hospitals may lag behind VHA hospitals, both hospital systems should continue to pursue evidence-based improvements in patient safety. Future research aimed at changing hospital practices should draw on established strategies for bridging the gap from research to practice in order to improve the quality of care for this vulnerable patient population.


Asunto(s)
Hospitales Comunitarios/estadística & datos numéricos , Hospitales Generales/estadística & datos numéricos , Hospitales de Veteranos/estadística & datos numéricos , Pacientes Internos/psicología , Errores Médicos/estadística & datos numéricos , Servicio de Psiquiatría en Hospital/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Errores Médicos/psicología , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Adulto Joven
8.
Tidsskr Nor Laegeforen ; 139(14)2019 Oct 08.
Artículo en Noruego, Inglés | MEDLINE | ID: mdl-31592608

RESUMEN

BACKGROUND: Since 2016, all health regions have been instructed to provide drug-free psychiatric treatment options. The evidence base for such treatment has been called for. At Jæren District Psychiatric Centre we therefore identified the patients' wishes for drug-free treatment. MATERIAL AND METHOD: One hundred patients were sequentially asked upon admission whether they would want a drug-free treatment programme, given that it was available. The patients' age, sex, diagnosis and medical history were recorded, as well as their experience with the use of psychoactive drugs and counselling. RESULTS: Altogether 52 out of the 100 patients would want a drug-free treatment programme if this were available. The largest proportion was registered among patients who had been coercively sectioned (10 out of 13 patients) and among those who experienced least benefit from their drugs (17 out of 25). Even among those who reported to benefit well from their drugs, a considerable proportion wanted a drug-free option (24 out of 58). The majority of the patients had long illness trajectories and a high consumption of psychoactive drugs. INTERPRETATION: The observation that a large proportion of the patients would want a drug-free treatment programme if this were available can be seen as a reflection of frustration caused by persistent symptoms, adverse effects and a large burden of suffering despite the use of medication. An alternative interpretation is that the patients had an insufficient understanding of their need for preventive treatment or for their need for treatment at all.


Asunto(s)
Pacientes Internos/psicología , Trastornos Mentales/terapia , Enfermos Mentales/psicología , Prioridad del Paciente , Adolescente , Adulto , Anciano , Internamiento Obligatorio del Enfermo Mental , Femenino , Humanos , Tratamiento Psiquiátrico Involuntario , Masculino , Trastornos Mentales/tratamiento farmacológico , Persona de Mediana Edad , Psicotrópicos/administración & dosificación , Psicotrópicos/uso terapéutico , Adulto Joven
9.
Z Gerontol Geriatr ; 52(Suppl 4): 229-242, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31628611

RESUMEN

BACKGROUND: Older people represent a risk group for acquiring or further development of delirium during hospitalization, therefore requiring suitable nonpharmacological delirium interventions. OBJECTIVE: This scoping review analyzed nonpharmacological intervention programs for older inpatients with or without cognitive decline on regular or acute geriatric wards to present the range of interventions. METHODS: A systematic literature search was conducted using scientific databases. A total of 4652 records were screened by two independent reviewers, leaving 81 eligible articles for full-text screening and 25 studies were finally included. Inclusion criteria were older patients ≥65 years in regular or acute geriatric wards and nonpharmacological multicomponent interventions. RESULTS: More than a half of the included studies (14, 56%) recruited patients with pre-existing cognitive decline as part of the study population and 12% focused exclusively on patients with cognitive decline. On average 11 intervention components were integrated in the programs and two programs included full coverage of all 18 identified components. CONCLUSION: Only few programs were described for older inpatients and even fewer regarding pre-existing cognitive decline. The low numbers of interventions and data heterogeneity restricted the assessment of outcomes; however, delirium incidence, as reported by two thirds of the studies was reduced by nonpharmacological multicomponent interventions.


Asunto(s)
Disfunción Cognitiva/epidemiología , Delirio/epidemiología , Delirio/terapia , Hospitalización/estadística & datos numéricos , Pacientes Internos/psicología , Tiempo de Internación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/psicología , Delirio/psicología , Femenino , Humanos , Incidencia , Pacientes Internos/estadística & datos numéricos , Masculino , Prevalencia , Factores de Riesgo , Resultado del Tratamiento
10.
BMC Health Serv Res ; 19(1): 740, 2019 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-31640706

RESUMEN

BACKGROUND: Despite an increase in studies showing the efficacy of lifestyle interventions in improving the poor health outcomes for people with severe mental illness (SMI), routine implementation remains ad hoc. Recently, a multidisciplinary lifestyle enhancing treatment for inpatients with SMI (MULTI) was implemented as part of routine care at a long-term inpatient facility in the Netherlands, resulting in significant health improvements after 18 months. The current study aimed to identify barriers and facilitators of its implementation. METHODS: Determinants associated with the implementation of MULTI, related to the innovation, the users (patients, the healthcare professionals (HCPs)), and the organisational context, were assessed at the three wards that delivered MULTI. The evidence-based Measurement Instrument for Determinants of Innovations was used to assess determinants (29 items), each measured through a 5-point Likert scale and additional open-ended questions. We considered determinants to which ≥20% of the HCPs or patients responded negatively ("totally disagree/disagree", score < 3) as barriers and to which ≥80% of HCPs or patients responded positively ("agree/totally agree", score > 3) as facilitators. We included responses to open-ended questions if the topic was mentioned by ≥2 HCPs or patients. In total 50 HCPs (online questionnaire) and 46 patients (semi-structured interview) were invited to participate in the study. RESULTS: Participating HCPs (n = 42) mentioned organisational factors as the strongest barriers (e.g. organisational changes and financial resources). Patients (n = 33) mentioned the complexity of participating in MULTI as the main barrier, which could partly be due to organisational factors (e.g. lack of time for nurses to improve tailoring). The implementation was facilitated by positive attitudes of HCPs and patients towards MULTI, including their own role in it. Open responses of HCPs and patients showed strong commitment, collaboration and ownership towards MULTI. CONCLUSIONS: This is the first study analysing the implementation of a pragmatic lifestyle intervention targeting SMI inpatients in routine clinical care. Positive attitudes of both HCPs and patients towards such an approach facilitated the implementation of MULTI. We suggest that strategies addressing organisational implementation barriers are needed to further improve and maintain MULTI, to succeed in achieving positive health-related outcomes in inpatients with SMI.


Asunto(s)
Salud Holística , Pacientes Internos/psicología , Trastornos Mentales/rehabilitación , Adulto , Femenino , Humanos , Estilo de Vida , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Innovación Organizacional
11.
J Leg Med ; 39(3): 213-227, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31626575

RESUMEN

Despite the high prevalence of mental incapacity for treatment decisions in hospitals (27.7%), there is little information about the relationship, if any, between mental capacity assessments based on clinical and legal criteria. We performed a cross-sectional study of mental incapacity for treatment decisions in 300 hospital inpatients in two hospitals in Ireland, using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and the legal definition of mental incapacity in Ireland's incoming Assisted Decision-Making (Capacity) Act 2015. We found that patients who lacked mental capacity according to the legal criteria scored significantly lower on all four subscales of the MacCAT-T (Understanding, Appreciation, Reasoning, and Communication) compared to those who had mental capacity according to the legal criteria. In light of the similarity between Ireland's legal definition of mental incapacity and legislative definitions in other jurisdictions (e.g. England and Wales), we conclude that legal assessments of mental incapacity in these countries accord closely with clinical assessments (as reflected in the MacCAT-T). Ireland's new mental capacity legislation should be implemented promptly in order to further operationalize Ireland's new legal definition of mental incapacity and provide patients with the supports they need to optimize their mental capacity for treatment decisions in hospitals.


Asunto(s)
Toma de Decisiones , Consentimiento Informado/legislación & jurisprudencia , Pacientes Internos/psicología , Competencia Mental/legislación & jurisprudencia , Anciano , Anciano de 80 o más Años , Comprensión , Estudios Transversales , Femenino , Humanos , Irlanda/epidemiología , Masculino , Pruebas de Estado Mental y Demencia , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica
12.
Z Gerontol Geriatr ; 52(Suppl 4): 273-281, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31664583

RESUMEN

BACKGROUND AND OBJECTIVE: Mobility decline and worsening of the cognitive status are all too often the result of acute hospital treatment in older patients. This is particularly pronounced in patients with pre-existing cognitive impairment. This study strived to analyze the routines of geriatric acute care and identify reasons and triggers for sedentary behavior during acute hospitalization of cognitively impaired inpatients. METHODS AND PATIENTS: A sample of 20 moderately cognitively impaired geriatric inpatients (average age 84 years) were recruited on an acute care ward. Information on persons attending the patient, daytime, location, context, patient's activity behavior and difficulty of action were collected by behavioral mapping over a period of 35 1­min timeslots and extrapolated to a period of 525 min. Routines were further analyzed via semi-structured interviews with five healthcare professionals (HCP). RESULTS: Relevant relations between various categorical and ordinal variables, such as patients' activity behavior, persons attending the patient, daytime, location, difficulty of action and contextual factors were found. Extrapolated data showed that patients spent 396.9 min (75%) in their room, 342.0 min (65%) were spent alone and 236.2 min (45%) lying in bed. The time patients spent alone was grossly underestimated by HCP. CONCLUSION: Time spent without company, lacking meaningful activities and continuous bedridden periods due to missing demands to leave the room might have led to time spent inactive and alone. These seem to be strong predictors for sedentariness. Routines of acute care should be reorganized to increase physical activity and thereby reduce sedentary behavior of this patient group.


Asunto(s)
Actividades Cotidianas , Disfunción Cognitiva/psicología , Pacientes Internos/psicología , Conducta Sedentaria , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/diagnóstico , Hospitalización , Humanos , Proyectos Piloto
13.
Am J Psychother ; 72(3): 75-83, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31533453

RESUMEN

In this article, a clinical protocol for delivering a flexible, spiritually integrated cognitive-behavioral therapy, called spiritual psychotherapy for inpatient, residential, and intensive treatment (SPIRIT), is presented, and its implementation is described.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Pacientes Internos/psicología , Espiritualidad , Humanos
14.
BMC Health Serv Res ; 19(1): 623, 2019 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-31481058

RESUMEN

BACKGROUND: Hospital accreditation is expected to improve health care quality and patient satisfaction. However, little and conflicting evidence is currently available to support its effect on patient outcomes, particularly patient experience. Hong Kong recently launched a pilot programme to test an infrastructure for accreditation of both private and public hospitals with the Australian Council on Healthcare Standards. This study aims to evaluate the longitudinal impact of hospital accreditation on patient experience in a publicly-funded university teaching hospital in Hong Kong. METHODS: Three cross-sectional surveys were conducted at three time points: 9 months pre- accreditation as baseline (T1), three (T2) and fifteen months (T3) post-accreditation. Acute care inpatients aged 18 to 80 were recruited on the second day of hospital admission to complete the Picker Patient Experience Questionnaire-15 (PPE-15). Baseline data was first compared to the 2005 Hong Kong average for public hospitals using t-tests. Data was then analyzed using ANOVA and multiple linear regression to evaluate differences across the three cross-sections and examine the effect of accreditation over time while controlling for covariates. RESULTS: 3083 patients (T1 = 896, T2 = 1093, T3 = 1094) completed the survey for a response rate of 83.5, 86.1, and 83.8%, respectively. The hospital baseline domain and summary patient experience scores differed from the Hong Kong public hospital average obtained from the 2005 Thematic Household Survey. All domain and summary patient experience scores declined (improved) over the study period (T1 to T3). The multiple regression results confirmed the time point score comparisons with declining (improving) parameter estimates for T2 and T3 for all domain and summary scores except the 'continuity and transition' domain, for which the declining coefficient was only significant at T3. CONCLUSIONS: While hospital accreditation has not been shown to improve patient outcomes, this study suggests the accreditation exercise may enhance patient experience. Moreover, it suggests the quality improvement initiatives associated with accreditation may address areas of concern emphasized by Hong Kong patients, such as involvement in care and emotional support from providers.


Asunto(s)
Acreditación/normas , Hospitales Públicos/normas , Satisfacción del Paciente , Calidad de la Atención de Salud/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Métodos Epidemiológicos , Femenino , Hong Kong , Hospitalización , Hospitales de Enseñanza/normas , Humanos , Pacientes Internos/psicología , Masculino , Persona de Mediana Edad , Mejoramiento de la Calidad/normas , Adulto Joven
15.
Australas J Ageing ; 38 Suppl 2: 98-106, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31496063

RESUMEN

OBJECTIVE: To evaluate the implementation of a model of care known as the Confused Hospitalised Older Persons (CHOPs) program to improve recognition, assessment and management of older persons with cognitive impairment (delirium and/or dementia) admitted to acute hospitals. METHODS: The model of care was implemented in six selected hospitals across New South Wales. Pre- and postimplementation medical record audits, environmental audits, and staff knowledge and care confidence surveys were performed. Interviews with clinical leads postimplementation identified enablers and barriers. RESULTS: There were significant increases in cognitive screening within 24 hours (OR = 3.32 [2.50-4.91]), delirium risk identification (OR = 4.04 [2.89-5.64]), assessment of cognitive impairment (OR = 2.55 [1.90-3.43]) and interaction with families (OR = 2.81 [2.09-3.79]). Staff education and care confidence were improved, and positive environmental changes occurred in all hospitals. Barriers and enablers to implementation were identified. CONCLUSION: The CHOPs program improved identification, risk assessment and management of cognitive impairment in older hospitalised patients.


Asunto(s)
Cognición , Disfunción Cognitiva/terapia , Delirio/terapia , Prestación Integrada de Atención de Salud/organización & administración , Demencia/terapia , Servicios de Salud para Ancianos/organización & administración , Hospitales , Pacientes Internos/psicología , Factores de Edad , Envejecimiento/psicología , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/psicología , Delirio/diagnóstico , Delirio/psicología , Demencia/diagnóstico , Demencia/psicología , Humanos , Auditoría Médica , Nueva Gales del Sur , Grupo de Atención al Paciente/organización & administración , Evaluación de Programas y Proyectos de Salud , Medición de Riesgo , Factores de Riesgo
16.
Nord J Psychiatry ; 73(8): 532-538, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31524552

RESUMEN

Aims: Patients may experience unfair reception when in contact with psychiatric services. The aims are to illuminate these perceptions, and the extent of inpatients' involvement in their care, and if degree of involvement depends on compulsory or voluntary care. Furthermore, we sought to determine if an educational intervention for staff members, including systematic listening and offering the inpatients involvement using microdecisions, affects the inpatients' experiences and the use of coercion. Materials and methods: We used a naturalistic setting case control design in two psychiatric wards for one year, including all inpatients (n = 685) of which 458 took part of the microdecision intervention. Structured direct interviews were carried out with inpatients based on the Discrimination and Stigma Scale (DISC), Dyadic OPTION, and CollaboRATE instruments before (n = 19) and after (n = 46) the intervention. Frequencies of coercive measures before and after the intervention were compared (n = 685). Results: Respondents subjected to the intervention experienced less discrimination related to psychiatric care compared to responders not subjected. Tendencies of improvements post intervention were found for some aspects of involvement, as attention to concerns and possibilities to ask questions. A decrease in the use of coercive measures at three and six months after the start of the intervention was observed. Conclusion: Results suggest that the intervention could decrease the inpatients' experiences of discrimination during psychiatric care as well as the use of coercion in the service. The Dyadic OPTION instrument showed a mixed picture with results implying improvements in some areas and impairments in others.


Asunto(s)
Coerción , Trastornos Mentales/psicología , Participación del Paciente/psicología , Servicio de Psiquiatría en Hospital , Autoimagen , Discriminación Social/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Toma de Decisiones/fisiología , Femenino , Humanos , Pacientes Internos/psicología , Masculino , Trastornos Mentales/terapia , Persona de Mediana Edad , Participación del Paciente/tendencias , Servicio de Psiquiatría en Hospital/tendencias , Psicoterapia/métodos , Psicoterapia/tendencias , Discriminación Social/tendencias , Adulto Joven
17.
Psychiatr Danub ; 31(Suppl 3): 486-489, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31488777

RESUMEN

Mixed states are often underdiagnosed, with important consequences in terms of worsening prognosis, frequent admission to the hospital, higher suicide risk and poorer quality of life. For this reason, we analyzed retrospective data from patients admitted in the Psychiatric Hospital from January 1st to April 30th 2019 to identify clinical features of the mixed states by administering the G.T. MSRS scale. Within the 90 subjects of the sample, the large majority (75%) met criteria for mixed state. Of those only 16 were discharged with a diagnosis of Affective Disorder, however 26 (30.9%) were prescribed a mood stabilizer. This study shows that there is a high prevalence of mixed states in the inpatient unit admission, which is demonstrated both from the prescription of mood stabilizers, and confirmed by the diagnosis of mixed states rated with the scale. The scale can be a useful instrument to detect early in the course if the hospitalization the presence of mixed state, in order to guide a tailored psychopharmacological treatment, and improve prognosis.


Asunto(s)
Pacientes Internos/psicología , Trastornos del Humor/diagnóstico , Trastornos del Humor/psicología , Servicio de Psiquiatría en Hospital , Humanos , Trastornos del Humor/tratamiento farmacológico , Pronóstico , Calidad de Vida , Estudios Retrospectivos
18.
Psychiatr Danub ; 31(Suppl 3): 490-496, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31488778

RESUMEN

BACKGROUND: Differentiating Borderline Personality Disorder (BPD) from Bipolar Disorder (BD) represents a very difficult challenge for clinicians. Dysphoria could be a possible key to differentiate these disorders. We currently define dysphoria as a complex and disorganized emotional state with proteiform phenomenology, characterized by a multitude of symptoms. Among them irritability, discontent, interpersonal resentment and surrender prevail. These dimensions can be detected using the Neapen Dysphoria Scale - Italian version (NDS-I). Dysphoria role in BPD has been highlighted by the recent theorization of the Interpersonal Dysphoria Model, according to which dysphoria could represent the "psychopathological organizer" of the BPD. On the other side, dysphoria role in BD has not yet been established. This is simply considered as an aspect, and not fundamental, of the symptomatology characterizing BD, especially in mixed states patients. The phenomenological analysis of the dimensional spectrum of dysphoria within BPD and DB could provide a valuable aid in the differential diagnosis between BPD and BD. AIMS: The aim of this paper is to verify if the dimensional spectrum of dysphoria differs between Borderline Personality Disorder (BPD) and Bipolar Disorder Spectrum (BD) through an observational comparative study SUBJECTS AND METHODS: In this study, 65 adult patients, males and females between the ages of 18 and 65, were enrolled from the Psychiatric Service of the Santa Maria della Misericordia Hospital in Perugia (PG), Italy, from January 1st 2018 to April 30th 2019. We have formed 2 groups. A BPD group composed of 33 patients (19 female patients, representing approximately 57.6% of the sample) and a BD group composed of 32 patients (18 Female patients, representing approximately 56.2% of the sample). Patient's comorbid with BD and BPD have been excluded from the study. After a preliminary assessment to exclude organic and psychiatric comorbidity, and after at least 72 hours from hospitalization, we administered them the Neapen Dysphoria Scale - Italian Version (NDS-I), a specific dimensional test for dysphoria. Starting from the dataset, with the aid of the statistical program SPSS 20, we have carried out a comparison between disorders groups selected and their NDS-I total score and subscales (irritability, discontent, interpersonal resentment, surrender); For this we have used the Mann-Whitney U test, a nonparametric test with 2 independent samples, by setting a significance level p<0.05. CONCLUSIONS: This study allowed us to explore and analyze dysphoria dimensions expressions in BPD and BD. Despite the small sample analyzed, the results show a significant different dimensional spectrum expression of the dysphoria between the two disorders. In particular, Irritability and Interpersonal Resentment dimensions show greater interest in BPD than BD spectrum. Further studies with a larger and stratified sample are needed to confirm these results.


Asunto(s)
Trastorno Bipolar/diagnóstico , Trastorno Bipolar/psicología , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno de Personalidad Limítrofe/psicología , Pacientes Internos/psicología , Adolescente , Adulto , Anciano , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Adulto Joven
19.
J Psychiatr Ment Health Nurs ; 26(7-8): 274-285, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31390122

RESUMEN

WHAT IS KNOWN ON THE SUBJECT?: Seclusion involves isolating a patient in a room away from other patients in order to contain aggressive behaviour, and it is used in psychiatric hospitals. Research has found that seclusion is often viewed by patients as negative; however, there is limited in-depth understanding of the deeply personal experience. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This systematic review found that the published research may have flaws with the quality of analysis, mainly due to limited researcher reflexivity. The review of qualitative research revealed that during seclusion, patients feel vulnerable, neglected and abused, disconnected from the experience and that it is dangerous to their mental health. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: For clinicians facilitating the seclusion process to use their therapeutic skills to provide patients with a sense of being cared for. For clinical supervision to allow space to explore interpersonal dynamics during seclusion in order to enhance therapeutic staff-patient interaction. Abstract Introduction There is limited understanding of patients' seclusion experience. A 2013 systematic review provides some insight; however, more knowledge is required in order to improve patient care. This is a systematic review of qualitative research into the patient experience of seclusion. The qualitative focus enables the phenomena to be the central focus. Question "What are adult psychiatric inpatients' experience of seclusion?" and "What is the quality of the applicable research?" Method Electronic searches for qualitative research published between 2006 and 2017 were undertaken. Data were excluded if it was not explicitly related to seclusion. Research was appraised using three standardized appraisal criterion. Themes were generated through thematic synthesis. Results Eight papers met inclusion criteria; four had been translated into English. Four themes were identified: "feeling vulnerable," "feeling neglected and abused," "disconnecting" and "seclusion is dangerous to mental health." Participants felt vulnerable and without control. They experienced staff and room as neglectful and abusive. Participants mentally disconnected. The experience threatened participants' mental health. Discussion Participants' experience is an amalgamation of interpersonal experience and the environment. Disconnecting may be a coping strategy. Implications for practice The findings have implications for seclusion practice, staff training and clinical supervision. Specific attention needs to be paid to the staff-patient interaction.


Asunto(s)
Pacientes Internos/psicología , Enfermos Mentales/psicología , Aceptación de la Atención de Salud/psicología , Aislamiento de Pacientes/psicología , Investigación Cualitativa , Adulto , Humanos
20.
Artículo en Inglés | MEDLINE | ID: mdl-31398821

RESUMEN

The aim of this paper is to describe frail older persons' experiences of hospital care of information and participation when being an inpatient at a hospital. A qualitative method was used. Data were collected at the hospital from 20 interviews with frail older patients, together with observations in the environment at the hospital ward. A content analysis was performed. Patients experienced not receiving information about their care and rehabilitation, or receiving such information in noisy surroundings. They experienced situations of misunderstanding related to their medication, which indicates the need for appropriate discharge calls for frail older patients. They expressed feelings of distress concerning the future, caused by hasty admissions or relatives' problems to handle the situation. The results highlight the need to receive appropriate information and to participate in decision-making. The level of health literacy should be taken notice of when giving information, using peaceful and quiet environments when informing frail older persons. Person-centered care should be recognized to a greater extent in order for healthcare professionals to give information to frail older people in a health literacy-friendly way. This might make it easier for frail older persons to participate in a partnership in care.


Asunto(s)
Comunicación , Anciano Frágil/psicología , Difusión de la Información/métodos , Pacientes Internos/psicología , Participación del Paciente/psicología , Atención Dirigida al Paciente/métodos , Anciano , Anciano de 80 o más Años , Toma de Decisiones , Femenino , Anciano Frágil/estadística & datos numéricos , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Participación del Paciente/estadística & datos numéricos
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